Approach to a dark spot on the conjunctiva

Although malignant melanoma most often develops in the skin, it can also arise in several layers of the eye. Therefore, new dark brown or black spots on the conjunctiva must be recognized during physical examination and then evaluated. When melanoma is suspected, there should be no hesitation in performing excisional biopsy under local anesthesia. The differential diagnosis includes melanocytic nevi and primary or secondary melanosis.